RU2802718C1 - Method for assessing the reserve capabilities of the skin cover of the back in patients with idiopathic scoliosis - Google Patents

Abstract

FIELD: medicine; orthopaedics; plastic surgery.

SUBSTANCE: invention can be used to assess the reserve capacity of the back skin of patients with scoliosis. The skin microcirculation, elastic properties of the skin are measured along the paravertebral and scapular lines of the back on the concave and convex sides in the proximal region, at the level of the apex of the deformation and in the distal region. The risk zone containing the skin with reduced blood perfusion and elasticity is determined. After that, at the indicated points, its perfusion is assessed and the area of greatest risk is determined when the blood perfusion value is less than or equal to 2.0 ml/min*100 g of tissue. At the same points, the elastic properties of the skin are determined and the area of least elasticity is identified, where the elasticity index is less than or equal to 7 g/(cm*deg.). The combination of reduced perfusion values less than or equal to 2.0 ml/min*100 g of tissue and skin elasticity, the elasticity value being less than or equal to 7 g/(cm*deg.), indicates the presence of reduced reserve capacity of the skin. The combination of perfusion indices of more than 2.0 ml/min*100 g of tissue and skin elasticity, the elasticity index of more than 7 g/(cm*deg.), indicates the presence of the necessary reserve capacity of the skin.

EFFECT: method provides an objective assessment of the reserve capabilities of the skin of the back by measuring the parameters characterizing such capabilities of the skin to ensure a favorable course of the postoperative period and reduce the length of stay in the hospital in patients with idiopathic scoliosis during surgical treatment of curvature.

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Description

Field of technology.

The invention relates to medicine, and can be used to assess the reserve capabilities (biomechanical and microcirculatory, perfusion) of the skin of the back of patients with scoliosis during treatment.

Assessing the features of the structural and functional state of the skin of the back in children and adolescents with spinal deformities of various origins is necessary for planning treatment and reducing the risk of complications in patients with idiopathic scoliosis after surgery to correct spinal curvature.

The biomechanical characteristics of the skin are traditionally determined by palpation. A known rotational compression test for determining skin tone and a test for the formation of skin folds, determining elasticity [Timofeev G. Methods of hardware examination of human skin. “Cosmetics and Medicine”, 2005, No. 4].

The main disadvantage of this method of studying the biomechanical characteristics of the skin is that it is approximate and indicative, does not have clear criteria and is influenced by the subjective factor of the researcher.

There is a known method of topographic tensoalgometry [RU 2474398], in which tensometry is performed in the projection of the paravertebral, scapular and posterior axillary lines of the back on the right and left by assessing the functional (biomechanical) state of soft tissues, including tensometry (assessment of the elasticity/firmness of the skin and subcutaneous tissue) and algometry (assessment of local muscle soreness) at each of the previously determined diagnostic points, followed by visual analysis of the results obtained to diagnose and evaluate the effectiveness of treatment of pathology of the musculoskeletal system (massage).

However, this method does not evaluate the degree of perfusion (microcirculation) of the skin, skin elasticity (tissue reserve) during spinal deformity.

There is a known method for diagnosing structural changes in the soft tissues of the paravertebral zone after surgical correction of the spine [RU 2687015]. The method improves the quality of diagnosis of postoperative complications during corrective surgeries on the spine by identifying hypoechoic and anechoic zones. The method includes examination of paravertebral soft tissues in the surgical operation area by horizontal scanning of the muscular apparatus along the length of the spine. An ultrasound examination is performed on the 2nd day after surgery in the projection area of the metal structure located in the spine. The scan is performed along the spine on both sides in the projection of the postoperative suture. A hypoechoic or anechoic zone of submuscular localization is identified, its anteroposterior size and maximum thickness are determined.

However, this method does not separately differentiate the condition of the skin of the back (in the area under study), its microcirculation and elastic properties.

The closest to the stated technical solution is the assessment of the plastic properties of the skin and microcirculation of the mid-thoracic and lumbar spine, 3-4 cm lateral to the spinous processes in adolescents with grade 2-3 idiopathic scoliosis (the angle of the apex of the main arch was 6-19 degrees), undergoing conservative treatment. The speed of propagation of a surface acoustic (shear) wave in the skin (SAW) was determined, for which an ASA device was used (acoustic skin analyzer - ASA, manufactured Moscow-Belgrade; with a sensor having a working area of 1 cm2 (Pat. No. 2340277). Range of change The surfactant was 10-300 m/s. Measurements were carried out in four different directions - longitudinal (parallel to the anatomical axis of the segment, [C(z)], transverse - perpendicular to the specified axis [C(x)] and diagonal 45 and 135 degrees of the Cartesian coordinate system [C(45) and C(135)].The proposed method determines the skin plasticity coefficient, calculated as the ratio of the surfactant before the functional test to the surfactant parameter after it, the skin of the back was tested in the prone position and when performing the Adams functional test. skin plasticity (Kpl) for each testing direction Kpl (z) - longitudinal, Kpl (x) - transverse, Kpl (45 deg.), Kpl (135 deg.) - diagonal (45 and 135 deg. Cartesian coordinate system, respectively (Pat. No. 2340277). Conducted in parallel with biomechanical testing, a study of microcirculation (laser Doppler flowmetry) and electrothermometry in the skin of the thoracic and lumbar back did not reveal significant differences in these indicators between the right and left areas, thoracic and lumbar regions (Grebenyuk L.A. et al. Methodology for determining the plastic reserves of the skin cover in patients with orthopedic pathology //Medical science and education of the Urals. - 2013. - T. 14. - No. 4. - P. 11-17).

The disadvantages of this technical solution are as follows. Not all parts of the back (upper thoracic region and scapular projection of the back) are examined. The process of researching and calculating skin plasticity is technically complex. The method is applicable for patients with idiopathic scoliosis who do not need surgical treatment, and does not improve the results of surgical treatment.

At the present stage of development of surgical services in large clinics of federal significance, with a large volume of surgical interventions, early recovery of patients and rapid discharge from hospital, subject to a favorable course of the postoperative period, is a priority task, the solution of which will increase the efficiency of large clinics of federal significance. A favorable outcome of surgical treatment in patients in the early postoperative period largely depends on accurate and timely diagnosis of the condition of soft tissues in the area of surgical intervention. Due to the fact that at the preoperative stage in adolescents with idiopathic scoliosis, complex patient positioning and ambiguous anatomical landmarks are the main sources of errors that mislead the researcher (doctor). Torso (back) surface measurements correlate very poorly with Cobb angle measurements [Patias et al. Patias et al.: A review of the trunk surface metrics used as Scoliosis and other deformities evaluation indices. Scoliosis 2010 5:12. doi:10.1186/1748-7161-5-12].

Thus, to improve the efficiency of medical care for patients with idiopathic scoliosis, it is necessary to study the reserves of the skin of the back (including parameters of microcirculation and elasticity) before surgery and planning treatment, to ensure favorable conditions for healing of the postoperative wound and to ensure the necessary reserves of skin for closing a postoperative wound, with an extended metal structure installed.

The essence of the invention.

The problem that the method is aimed at is assessing the reserve capabilities of the skin of the back in patients with idiopathic scoliosis during surgical treatment.

The technical result consists in providing an objective assessment of the reserve capabilities of the skin of the back, by measuring parameters characterizing such capabilities of the skin, to ensure a favorable course of the postoperative period and reduce the length of hospital stay in patients with idiopathic scoliosis during surgical treatment of curvature.

The technical result is achieved by the fact that in the method for assessing the reserve capabilities of the skin of the back in patients with idiopathic scoliosis, skin microcirculation, elastic-elastic properties of the skin are measured along the paravertebral and scapular lines of the back on the concave and convex side in the proximal region, at the level of the apex of the deformity and in in the distal region, a risk zone is determined that contains skin with reduced blood perfusion and elasticity, which reduce the supply of tissue required to close the surgical wound; Moreover, the study of microcirculation and elastic-elastic properties of the skin is carried out using a laser Doppler flowmeter and an elastomer at points throughout the area planned for installation of a transpedicular fixation system, along the paravertebral and scapular lines on the right and left side of the back in the area of the apex of the deformity arc, as well as proximally and distal from it; after conducting studies of the microcirculation of the skin of the back at the indicated points, its perfusion is assessed and the area of greatest risk is determined when the blood perfusion value is less than or equal to 2.0 ml/min * 100 g of tissue; at the same points, the elastic-elastic properties of the skin are determined and the area of least elasticity is identified, where the elasticity index is less than or equal to 7 g/(cm deg); a combination of reduced perfusion indicators less than or equal to 2.0 ml/min*100 g of tissue and skin elasticity, an elasticity indicator less than or equal to 7 g/(cm*deg), indicates the presence of reduced reserve capacity of the skin, a combination of perfusion indicators greater than 2.0 ml/min*100 g of tissue and skin elasticity, the elasticity index is more than 7 g/(cm*deg), indicates the presence of the necessary reserve capabilities of the skin.

Thus, studies are carried out throughout the intended area of installation of the transpedicular fixation system (metal structures), which makes it possible to plan surgical intervention and ensure a sufficient supply of skin to avoid complications in the early postoperative period.

The combination of reduced perfusion rates ≤ 2.0 ml/min*100 g of tissue and skin elasticity, elasticity index ≤ 7 g/(cm*deg), indicates the presence of reduced reserve capabilities of the skin in this area, which must be taken into account when planning and performing surgical intervention, limiting the tension of the skin in the specified area.

The combination of perfusion indicators of more than 2.0 ml/min*100 g of tissue and skin elasticity, an elasticity indicator of more than 7 g/(cm*deg), indicates the presence of the necessary reserve capabilities of the skin of the back in this area of installation and sufficient for closing an extended metal structure.

The invention is illustrated by images (clinical example):

Figure 1 - Patient R. 13 years old. X-ray of the spine in the frontal plane. a - before treatment. b - 3 days after surgery.

Fig.2 - Patient R., 13 years old. Photo of the back a - before treatment. b - 9 days after surgery.

Fig. 3. - Patient S., 17 years old. X-ray of the spine in the frontal plane. a - before treatment. b - 6 days after surgery.

Fig. 4. - Patient S., 17 years old. Photo of the back a- before treatment. b - 8 days after surgery.

Fig. 5 - photo of the patient's back. The points of dermatome research are shown on the skin of the back.

The figure indicates:

P - paravertebral lines;

L - scapular lines;

Location of points for studying microcirculation and elastic-elastic properties of the skin relative to the apex of deformation:

1 - proximally;

2 - at the level of the apex of deformation;

3 - distal.

Implementation of the invention.

In a method for assessing the reserve capacity of the skin of the back in patients with idiopathic scoliosis, the following is performed:

- measurement of microcirculation parameters (blood perfusion) of the skin;

- measurement of parameters of elastic-elastic properties;

- measurement is performed along the paravertebral and scapular lines on the concave and convex side in the proximal region, at the level of the apex of the deformity and in the distal region,

- determine the risk zone containing skin with reduced parameters of microcirculation (blood perfusion) and elasticity, reducing the supply of tissue necessary to close the surgical wound;

- the study of microcirculation and elastic-elastic properties of the skin is carried out using a laser Doppler flowmeter and an elastomer;

- study of microcirculation and elastic-elastic properties of the skin is carried out at points along the area planned for installation of the transpedicular fixation system, along the paravertebral and scapular lines on the right and left side of the back in the area of the apex of the deformation arc, dermatome Th4-Th10, (dermatome is the area skin), as well as proximally, dermatome C5-Th1, and distally, dermatome Th12-L2, (or in the area of the anti-arc, compensatory arc) from it (Fig. 5).

- assess perfusion (use laser Doppler flow meter Transonic System BL-21, USA) and determine the area of greatest risk where perfusion is less than or equal to ≤ 2.0 ml/min * 100 g of tissue).

- assess the elastic-elastic properties of the skin (use an elastometer [Shchurov V.A. Effect of Tension Stress by Surgical Lengthening of Limbs with Growth Retardation on Biomechanical and Functional Properties of Tissues Chapter 23: R. 283-298. In: Poitout D. (eds ) Biomechanics and Biomaterials in Orthopedics. Springer, London. 2016. https://doi.org/10.1007/978-1-84882-664-9_21], in the same study area, and identify the area of least elasticity (i.e. areas with limited skin supply) where the elasticity index is less than or equal to ≤ 7 g/(cm deg)

- a combination of reduced perfusion indicators ≤ 2.0 ml/min*100 g of tissue and skin elasticity, elasticity indicator ≤ 7 g/(cm*deg), indicates the presence of reduced reserve capacity of the skin in this area, a combination of perfusion indicators ≥ 2.0 ml/min*100 g of tissue and skin elasticity, elasticity index ≤ 7 g/(cm*deg), indicates the presence of the necessary reserve capabilities of the skin in this area.

Thus, studies are carried out throughout the intended area of installation of the transpedicular fixation system (metal structures), which makes it possible to plan surgical intervention and ensure a sufficient supply of skin to avoid complications in the early postoperative period.

The combination of reduced perfusion rates ≤ 2.0 ml/min*100 g of tissue and skin elasticity, elasticity index ≤ 7 g/(cm*deg), indicates the presence of reduced reserve capabilities of the skin in this area, which must be taken into account when planning and performing surgical intervention, limiting the tension of the skin in the specified area.

The combination of perfusion indicators ≥ 2.0 ml/min*100 g of tissue and skin elasticity, elasticity indicator ≤ 7 g/(cm*deg), indicates the presence of the necessary reserve capabilities of the skin of the back in this area of installation and sufficient for closing an extended metal structure.

Clinical case 1.

Patient R., 13 (Fig. 1; 2) years old, was admitted for treatment with a diagnosis of idiopathic scoliosis. According to Lenke classification 6CN. On radiographs of the thoracic and lumbar spine in 4 projections, with an inclination to the right and left, it is determined: a pronounced right-sided deformity of the spine in the frontal plane with an angle of 62 degrees with the apex on the body of the 6th thoracic vertebra, a left-sided deformity with an angle of 80 degrees with the apex on body of the 2nd lumbar vertebra (Fig. 2a). In the sagittal plane with an angle of 35 degrees, there is a pronounced torsion of the vertebral bodies; when tilted to the right, the angle is 59 and 99 degrees, respectively; when tilted to the left, it is 55 and 58 degrees, respectively.

A visual clinical examination of the skin of the back showed the presence of pathological changes: a few atrophic stripes - “striae” in the lumbar spine; acne, papulo - pustular form; follicular hyperkeratosis; "grater" symptom. Manifestations of acne are rashes, also localized on the skin of the face, represented by papular-pustular hemispherical elements of a red-pink color up to 0.2-0.4 cm in size, superficial pustules, extinguished with a fucorcin solution.

To assess the reserve capacity of the skin of the back, the following was carried out:

- measurement of microcirculation parameters (blood perfusion) of the skin;

- measurement of parameters of elastic-elastic properties;

- measurement is performed along the paravertebral and scapular lines on the concave and convex side in the proximal region, at the level of the apex of the deformity and in the distal region,

- determined the risk zone containing skin with reduced parameters of microcirculation (blood perfusion) and elasticity, reducing the supply of tissue necessary to close the surgical wound;

- the study of microcirculation and elastic-elastic properties of the skin is carried out using a laser Doppler flowmeter and an elastomer;

- study of microcirculation and elastic-elastic properties of the skin is carried out at points along the area planned for installation of the transpedicular fixation system, along the paravertebral and scapular lines on the right and left side of the back in the area of the apex of the deformation arc, dermatome Th4-Th10, (dermatome is the area skin), as well as proximally, dermatome C5-Th1, and distally, dermatome Th12-L2, (or in the area of the anti-arc, compensatory arc) from it (Fig. 5).

- assessed perfusion (use laser Doppler flow meter Transonic System BL-21, USA) and determine the area of greatest risk where perfusion is less than or equal to ≤ 2.0 ml/min * 100 g of tissue). Indicators of capillary blood flow in the skin of the back of patient R. In Table 1.

Table 1 - Indicators of capillary blood flow of the skin of the back of patient R., 13 years old Capillary blood flow (ml/min/100 g) Scapula projection Projection of the paravertebral region On right Left On right Left 1 2 3 1 2 3 1 2 3 1 2 3 4.9 4.5 3.4 5.1 5.8 3.9 4.4 4.3 3.7 4.5 4.6 3.0

1-proximal section (dermatome C ₅ -Th ₁ ); 2 - apex of the arc of right-sided deformation (dermatome Th ₆ -Th ₇ ); 3 - left-sided apex (dermatome Th ₁₂ -L ₂ ). Normally, in the thoracic back region the values are 4.5-5.0 ml/min*100 g, in the lumbar region 3.5-4.0 ml/min*100 g.

Skin perfusion in all study areas was greater than 2 mil/min*100 g of tissue.

- the elastic-elastic properties of the skin were assessed (using an elastometer [Shchurov V.A. Effect of Tension Stress by Surgical Lengthening of Limbs with Growth Retardation on Biomechanical and Functional Properties of Tissues Chapter 23: R. 283-298. In: Poitout D. (eds ) Biomechanics and Biomaterials in Orthopedics. Springer, London. 2016. https://doi.org/10.1007/978-1-84882-664-9_21], in the same study area, and identify the area of least elasticity (i.e. areas with limited skin supply) where the elasticity index is less than or equal to ≤ 7 g/(cm deg).

Indicators of the study of skin elasticity (Table 2).

Table 2 - Indicators of elasticity of the skin of the back of patient R., 13 years old. Elasticity index (g/(cm⋅deg) Scapula projection Projection of the paravertebral region On right Left On right Left 1 2 3 1 2 3 1 2 3 1 2 3 9.0 9.0 9.0 9.0 9.0 9.0 8.0 7.0 9.0 8.0 8.0 9.0

1-proximal section (dermatome C ₅ -Th ₁ ); 2 - apex of the arc of right-sided deformation (dermatome Th ₆ -Th ₇ ); 3 - left-sided apex (dermatome Th ₁₂ -L ₂ ). Normally, in the thoracic back region the values are 11-12 ml/min*100 g, in the lumbar region 10-11 ml/min*100 g.

The elasticity index at most study points was 8-9 g/(cm·deg). The exception was the study point on the right in the area of the right-sided deformity arc (convex side) (7 g/(cm·deg). But in this area a sufficient level of perfusion was recorded (4.3 ml/min * 100 g).

Subsequently, an operation was performed: correction of the deformity of the spine and chest using the Medtronic Th5-L5 system. Posterior spinal fusion. Neuromonitoring.

During the operation, after treating the surgical field three times with an alcohol solution of chlorhexidine, a skin and soft tissue incision was made in the projection of the Th5-L5 vertebrae. The paravertebral muscles were separated with a raspator, and the posterior supporting column was skeletonized. Transpedicular, bilateral, intracorporeal reference points of the Medtronic system were installed in Th5,6,8,10,12,L2, 4-5. Image intensifier control: the position of the metal structure is correct. Facetotomy throughout. Installation of longitudinal beams. Corrective maneuver. Distraction along the concave sides of the deformity. Final tightening of the nuts. Posterior spinal fusion. Hemostasis control - dry. Two active drains are installed. The wound is sutured in layers with interrupted sutures. Intradermal skin suture. Aseptic dressing. Neuromonitoring was performed during the operation: without any features.

3 days after the operation, radiographs of the thoracic and lumbar spine show: the condition after surgical treatment, the fixation structure is stable, no bone resorption was detected. The deformation of the spine in the frontal plane remains with an angle of 26 degrees in the thoracic region (58% decrease) and 22 degrees (72% decrease) in the lumbar region.

In the postoperative period, the wound heals by primary intention, the bandage is dry, the staples are removed and an aseptic dressing is applied. The patient is vertically positioned in a semi-rigid thoracolumbar corset with a physical therapy instructor and walks within the ward. Follows orthopedic regimen. Fixation of the lower extremities with compression stockings.

Clinical case 2 (Fig.3;4). Patient S., 17 years old, was admitted for treatment with a diagnosis of idiopathic scoliosis. According to Lenke classification 3ВN. Radiographs of the thoracic and lumbar spine reveal: right-sided deformity of the spine in the frontal plane with an angle of 37 degrees, the apex on the body of the 8th thoracic vertebra, left-sided deformity with an angle of 31 degrees, with the apex on the body of the 3rd lumbar vertebra, in the sagittal plane 33 degrees, with apex on the 8th thoracic vertebra. When tilted to the right - 38\50 degrees, respectively, to the left - 46\25 degrees, respectively. Rotation of vertebral bodies in the thoracic and lumbar spine.

A visual clinical examination of the skin of the back reveals dermatopathological manifestations characteristic of the papulopustular form of acne: pink papules, up to 0.3 cm in size, hemispherical and conical in shape, a black dot in the center of the nodule, a few pustules with cloudy contents, a halo of hyperemia on the periphery. In places where the elements have resolved, there are small pigment spots and atrophic scars. The listed pathological changes are also localized on the skin of the face.

To assess the reserve capabilities of the skin of the back in patients with idiopathic scoliosis, microcirculation (perfusion) of the skin, elastic-elastic properties were measured along the paravertebral and scapular lines on the concave and convex side in the proximal region, at the level of the apex of the deformity and in the distal region (or in the zone anti-arch, compensatory arch), and determined the risk zone containing skin with reduced blood perfusion, elasticity, reducing the supply of tissue necessary to close the surgical wound.

Microcirculation of the skin of the back was studied using a laser Doppler flowmeter (Transonic System BL-21, USA) (Table 3) along the paravertebral and scapular lines on the right and left side of the back in the proximal region (dermatome C5-Th1), in the area of the apex of the right-handed arch deformation (dermatome Th8-Th9), then the left-sided arc of deformation (dermatome L1-L3). Thus, research is carried out throughout the area of installation of the proposed metal structure.

Table 3 - Indicators of capillary blood flow of the skin of the back of patient S., 17 years old

Capillary blood flow (ml/min/100 g) Scapula projection Projection of the paravertebral region On right Left On right Left 1 2 3 1 2 3 1 2 3 1 2 3 3.9 3.8 2.5 3.3 2.2 2.4 3.3 1.8 3.1 3.2 3.8 2.0

1-proximal section (dermatome C ₅ -Th ₁ ); 2 - apex of the arc of right-sided deformation (dermatome Th ₈ - _{Th 9} ); 3 - left-sided apex (dermatome L ₁ -L ₃ ). Normally, in the thoracic back region the values are 4.5-5.0 ml/min*100 g, in the lumbar region 3.5-4.0 ml/min*100 g.

Table 4 - Indicators of elasticity of the skin of the back of patient S., 17 years old Elasticity index (g/(cm⋅deg) Scapula projection Projection of the paravertebral region On right Left On right Left 1 2 3 1 2 3 1 2 3 1 2 3 9.0 8.0 7.0 9.0 8.0 10.0 9.0 6.0 9.0 9.0 7.0 7.0

1-proximal section (dermatome C ₅ -Th ₁ ); 2 - apex of the arc of right-sided deformation (dermatome Th ₈ - _{Th 9} ); 3 - left-sided apex (dermatome L ₁ -L ₃ ). Normally, in the thoracic back region the values are 11-12 ml/min*100 g, in the lumbar region 10-11 ml/min*100 g.

At several points of the study, a low level of perfusion (1.8 - 2.0 ml/min * 100 g) was combined with low elastic properties of the skin (6-7 g/(cm deg): in the paravertebral projection on the convex side (right ) right-sided deformation (dermatome Th8-Th9); on the left side (convex side) left-sided deformation (dermatome L1-L3). In the scapular projection in the zone of left-sided deformation on the right side (concave side) (dermatome L1-L3).

Subsequently, an operation was performed: correction and final posterior instrumental fixation of the spine using the “De puy Spine” system at the Th3-L3 level. Facetotomy throughout. Posterior spinal fusion.

During the operation, after treating the surgical field three times with an alcohol solution of chlorhexidine, an incision was made in the skin and soft tissues in the projection of the Th3-L3 vertebrae. The rear support column is skeletonized. Support points of the DePyu Expedium system are installed transpedicularly bilaterally into the bodies of Th3,4,6,8,10,12,L2,3 vertebrae. Image intensifier control: position is correct. Installation of longitudinal rods, corrective maneuver. Image intensifier control: correction 100%. Final tightening of the nuts. The rigidity of the structure is supplemented by two transverse connectors. Decortication of vertebral arches and facetotomy throughout. Allobone is laid along the structure. Active drainage installed. Hemostasis control - dry. The wound is sutured in layers with interrupted sutures. Intradermal skin suture. Aseptic dressing.

6 days after the operation, radiographs of the thoracic and lumbar spine show a right-sided spinal deformity in the frontal plane with an angle of 12 degrees (68% decrease), with its apex on the body of the 8th thoracic vertebra, a left-sided deformity with an angle of 11 degrees (64% decrease) , with the apex on the body of the 3rd lumbar vertebra, in the sagittal plane 21 degrees (36% decrease), with the apex on the 8th thoracic vertebra.

In the postoperative period, there was a need for additional sutures, especially in the lumbar region. On the dressing, on the 8th day after surgery: the dressings are dry and clean. Treatment of postoperative suture with 0.5% chlorhexidine solution. The seams are good. The wound heals by primary intention. In n/3 of the postoperative suture there is a single interrupted suture. There is no swelling or hyperemia of soft tissues in the area of surgical treatment. There are no signs of inflammation. Change of bandages. Aseptic dressings. The patient is vertically positioned in a semi-rigid thoracolumbar corset with a physical therapy instructor and walks within the ward. Follows orthopedic regimen. Fixation of the lower extremities with compression stockings.

Claims (1)

A method for assessing the reserve capabilities of the skin of the back in patients with idiopathic scoliosis, characterized by measuring skin microcirculation, elastic-elastic properties of the skin along the paravertebral and scapular lines of the back on the concave and convex sides in the proximal region, at the level of the apex of the deformity and in the distal region , determine the risk zone containing skin with reduced blood perfusion and elasticity, which reduce the supply of tissue necessary to close the surgical wound; Moreover, the study of microcirculation and elastic-elastic properties of the skin is carried out using a laser Doppler flowmeter and an elastomer at points throughout the area planned for installation of a transpedicular fixation system, along the paravertebral and scapular lines on the right and left parts of the back in the area of the apex of the deformity arc, as well as proximally and distal from it; after conducting studies of the microcirculation of the skin of the back at the indicated points, its perfusion is assessed and the area of greatest risk is determined when the blood perfusion value is less than or equal to 2.0 ml/min * 100 g of tissue; at the same points, the elastic-elastic properties of the skin are determined and the area of least elasticity is identified, where the elasticity index is less than or equal to 7 g/(cm*deg.); a combination of reduced perfusion indices less than or equal to 2.0 ml/min*100 g of tissue and skin elasticity, an elasticity indicator less than or equal to 7 g/(cm*deg.), indicates the presence of reduced reserve capacity of the skin, a combination of perfusion indices greater than 2, 0 ml/min*100 g of tissue and skin elasticity, the elasticity index is more than 7 g/(cm*deg.), indicates the presence of the necessary reserve capabilities of the skin.